AFFIRMATION___DISCLOSURE_FORM.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically addressing restrictions on services performed by Russian companies or institutions. The form is executed by Palmer Brothers Concrete, located in Bowling Green, Ohio, and is associated with Executive Order 2022-02D and related state procurement guidelines. The document outlines compliance requirements for state contracts, particularly focusing on prohibitions against offshore services and data storage outside the United States.

The contract appears to have no subcontractors, with the contractor indicating "Not Applicable" in those sections. The primary location of business and service performance is 1265 W Gypsy Line Rd in Bowling Green, Ohio 43402. The form is part of a contract or bid associated with Executive Order 2022-02D, dated 2022-02D, and requires the contractor to affirm that no services will be performed in Russia. The document was signed on 4-7-2025 by a representative with the title of Accounts Receivables, affirming the company's commitment to the specified contractual and executive order requirements.